County doctors are paid less

I am very saddened by the picture Times journalist Dan Borenstein tries to paint with his recent column regarding the payroll of physicians working for Contra Costa County.

While I agree county staff physicians should not be paid with misleading tactics of call pay, the context of the greater picture is that there's a large number of physicians who are leaving the employ of Contra Costa County. This is in large part because physician compensation in this county is the lowest of any Bay Area county, and that is including the additional call pay.

This pay difference includes comparisons with Alameda, San Francisco, Santa Clara, Solano, and San Mateo counties. In addition, other local private organizations, such as Kaiser Permanente and John Muir, are paying their physicians 75 percent more than Contra Costa County.

If you factor in Kaiser's large sign-on bonus, you could make an argument that Kaiser pays their family physicians double that of Contra Costa County. Kaiser also offers better benefits and retirement.

Many of the physicians who have stayed with the county do so because of their loyalties in serving a largely disadvantaged socio-economic population that does not have the luxury of privatized insurance.


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These patients are not typically the healthy subset of the population, but rather are very complex with multiple medical problems. Oftentimes, these patients have been unable to access care until they are very ill and difficult to treat.

Instead of promoting the doctors serving the most difficult populations of this county, despite very large pay discrepancies, Borenstein's column inflames the public against those very physicians.

Dr. Daniel Lee

El Cerrito

No defense for dengue fever

A casual mention in a recent newspaper article informed us that a mosquito that was unknown in this area had been identified near Fresno.

This most unwelcome newcomer is the Aedes aegypti. Not long ago, this insect was unknown outside Africa, but now is common in more than 100 countries.

Among its least admirable characteristics is its ability to be a vector for yellow fever and dengue fever. Dengue fever, or "break-bone fever" as it is commonly known because of its most painful symptoms, infects some 100,000 people annually, and kills more than 20,000 of them.

Yellow fever is not a disease that most of us are looking for, but there is inoculation for it. For dengue there is no defense and no significant treatment.

While mosquitoes have a life of only a few weeks, they breed at extremely high speed and are very difficult to eliminate. The only successful strategy followed, to date, is to cause a gap in the life-cycle.

The female, who is the sole spreader of disease, must lay her eggs in undisturbed pools of water. These can be as small as a spoonful and as large as a lake. Eliminating the pools can cause the gap and eliminate future generations of mosquitoes.

In areas of the world where mosquito-borne diseases have been eradicated, this has been accomplished only by draining (or treating) all standing pools. Typically, the procedure involves little or no expenditure, but it seems to only come about when all local residents are so aware of the rewards and the punishment involved in draining or not draining, that they take action.

Until now, in Northern California, mosquitoes have been an itchy nuisance. That is likely to change soon. Given the worldwide mobility of California's population, it would seem to be merely a matter of time until the first cases of dengue fever are reported.

It is to be hoped that California's Health Department will launch an effective publicity campaign, and that schools, Scouts, service organizations, churches, news media, etc., recognize how their combined efforts to inform and motivate the public can predictably prevent much suffering. The earlier their successful action, the easier eliminating the Aedes aegypti -- and consequently, dengue fever -- will be.

W. Frederick Shaw

El Cerrito

Letter title is misleading

This is regarding the Aug. 9 letter from John Hitchen, "Social Security opt-out is damaging." The title of the letter is misleading, in that it suggests BART employees have opted-out.

I agree with the first paragraph of his letter, that BART employees (and other state and local government employees) do not participate in Social Security. However, that nonparticipation should be explained.

The federal government cannot tax state and local government entities (through Federal Insurance Contributions Act, known as FICA). Therefore, for public employees to participate in the Social Security system, their employer must voluntarily "opt-in" and sign an agreement with the Social Security Administration.

It is not an "accounting trick," as Hitchen wrote in his letter.

Michal Ouffutt

El Cerrito

No sympathy for strikers

This is in response to Sal Spataro's Aug. 9 letter about toning down the BART rhetoric.

His comment about BART stepping up to the plate during the 1989 earthquake rubbed me the wrong way. BART running extra trains and going above and beyond the call of duty was the right thing to do during a catastrophic event such as the earthquake. It would have been more of a nightmare, not to mention a public relations disaster, if they had not.

I am one of the 200,000 riders that take BART every day. During the strike, I traveled almost three hours to get to San Francisco and three and a half hours to get home.

I'm sorry, but I cannot feel bad for BART employees when their highest paid janitor is earning $80,000. There are many people who take BART every day who are barely making a living wage trying to provide for their families.

Let's prohibit public transit workers from going on strike. Please, let this strike be the last one.

Crystal A. Garland

Hercules

Thirty-eight years is enough

A 1975 California statute, known as the Medical Injury Compensation Reform Act, sets unfair tort limitations that cap the amount medical malpractice victims can receive on noneconomic damages to $250,000, which has disregarded any adjustments for annual inflation for more than 38 years since the law's enactment.

Due to MICRA's immutable tort limit, the financial culpability of doctors has remained fixed, if not diminished over decades, on how much a doctor owes through malpractice insurance for jury-determined negligence toward a harmed patient, regardless if the severity spans from induced paralysis to death.

While opponents claim malpractice insurance companies are nonprofit entities, these insurance companies' combined loss ratio -- estimated claims payouts divided by the premium earned -- have dramatically fallen to a low five-year average ratio of 26.47 percent and, thus, provided higher profits at the expense of "capping" victim compensation.

This outdated tort limit has undermined malpractice victims' abilities to pursue civil cases that normally require months to establish and years to settle, and ultimately squandered victims' prospects for restitution concerning deprived opportunities in their afflicted lives.

Andrew Woo

Berkeley